Insomnia

Living Well in Myanmar

Difficulty sleeping?  Don't reach for pills right away

For various reasons, people sometimes have trouble falling asleep and staying asleep. Insomnia is a common problem for my patients in Yangon and California. Unaddressed, it can lead to fatigue, anxiety, depression and short-temperedness.

In both Myanmar and the United States, doctors often quickly prescribe medications to help patients sleep. In the US the drug might be Zolpidem, which is not approved for long-term use and now carries a warning that advises people not to drive the day after taking the medicine.  In Myanmar, the most common sleep-aid seems to be Diazepam (Valium), which not only causes problems with addiction but also stays in the body too long to be a responsible sleep agent. 

Rather than take pills, a healthier first approach to improving sleep is focusing on sleep hygiene. Sleep hygiene involves changing behaviour to complement the body’s natural circadian rhythm. Talk with your doctor first to make sure no medical conditions are compromising your sleep. Then consider the following ideas:

·      Go to bed at the same time every night. Choose that time according to when you feel slightly sleepy. The idea is to get your sleep cycle into a regular rhythm.

·      Use your bed and bedroom for sleep and sex only. No other non-sleep activities should take place in the bedroom.  This means no watching TV, no using the computer, no eating, etc.

·      Don’t sleep anywhere besides your bed. Avoid napping on couches or falling asleep in other rooms.

·      Make your sleeping environment comfortable.  This can be difficult in Myanmar and very much depends on your socioeconomic status.. A quiet space with low light and a comfortable temperature is best.

·      Identify a “wind down” technique that works for you. Attempt to take a break from everyday anxieties by bathing, meditating, listening to music or drinking herbal tea.

·      If you lie in bed and are struggling to fall asleep, or you wake up in the night and can’t fall back to sleep, then get out of bed and do something non-stimulating. This could mean writing in a journal, reading an unexciting book or reviewing the warranty on your refrigerator. Be careful to avoid bright light. Don’t lie in bed watching the clock and getting frustrated. Try to limit the amount of time that you’re awake in bed. If you’re not sleeping after 20 minutes get out of bed and try a boring activity.

·      Establish a regular time to wake up each morning. Use an alarm clock and try not to vary the time by more than 1 hour. If possible, get daylight exposure within a few minutes of waking up in the morning.

·      Eat healthy and stick to regular meal times. Dinner in particular should be around the same time every night, 2-3 hours before you go to bed.

·      Avoid caffeinated drinks after lunchtime. Limit alcohol to one glass per day.

·      A regular exercise routine can be helpful, but limit strenuous activity within 2 hours of bedtime.

When further intervention is required, the doctor and patient can consider a carefully planned program of sleep restriction. The idea is to use sleep deprivation to build physiologic pressure to sleep. For example, the patient might begin by restricting time in bed to 5 hours per night. Once they are able to sleep for 4 ½ of those 5 hours, they would increase their total time in bed to 5.5 hours. The goal is to continue this pattern of increasing time in bed by about 30 minutes per week with the hope of eventually reaching an adequate amount of sleep.

These behaviours, if implemented consistently over several weeks, often get my patients sleeping better, leading them to thrive in other aspects of their lives as well. If you’re at the point of wanting to discuss this with your doctor, a good start is to keep a diary in which you estimate how much of the night you’re spending in bed and how much you’re actually sleeping. The information will be a basis from which to start making behavioural changes.

gelsdorfMD@gmail.com  © Christoph Gelsdorf 2013